Checking Children’s Cholesterol to Reduce Future Risks

A friend called recently for a second opinion about a cholesterol test ordered by her daughter’s pediatrician. Was it really necessary to check her 4-year-old’s cholesterol level? Even if it was found to be high, was there anything to do about it?

We used to believe that atherosclerosis, a narrowing of the arteries due to fat buildup, did not develop until late in life. Now we know that this disorder, which can lead to coronary heart disease and stroke, can begin early in life if a child’s cholesterol levels are elevated.

To reduce the future risk of heart attack and stroke, children with high blood cholesterol must be identified and steps taken to keep their cholesterol levels in the healthy range.

Two major factors influence what a child’s cholesterol level will be: diet and heredity. A diet high in cholesterol and fat, particularly animal fat and saturated vegetable fat, promotes higher blood cholesterol levels. Some children are even more susceptible to this problem because of an inherited tendency, and may have high blood cholesterol levels even if they eat carefully.

*

To identify children with high blood cholesterol, the American Academy of Pediatrics recommends routine cholesterol screening for the following groups of children, ages 2 through 18.

* Children with biological parents or grandparents who, at 55 or younger, were diagnosed with coronary atherosclerosis. This includes parents or grandparents who had coronary artery disease detected on an angiogram as well as those who underwent angioplasty or coronary artery bypass surgery.

* Children with parents or grandparents who, at 55 years of age or less, suffered a myocardial infarction (heart attack), angina pectoris (chest pain), peripheral vascular disease, cerebrovascular disease (strokes or transient ischemic attacks, also called mini-strokes) or sudden cardiac death.

* Children of a parent with blood cholesterol of 240 milligrams per deciliter (mg/dl) or greater.

* Children whose parental or grandparental history is unknown.

Cholesterol screening may also be appropriate in children who have risk factors for coronary heart disease, such as adolescents who smoke cigarettes, have high blood pressure or are overweight.

If the test is done because a parent has high blood cholesterol, the total blood cholesterol should be measured. When the total cholesterol is 170 mg/dl or greater, a more detailed lipoprotein analysis should be obtained (this test measures levels of LDL cholesterol, the so-called bad cholesterol, and HDL cholesterol, the so-called good cholesterol). Intervention is recommended when the LDL is 110 mg/dl.

If a child is being tested because a parent or grandparent had premature cardiovascular disease, the initial test should be a lipoprotein analysis.

*

In most children with high cholesterol, changing to a low-fat, low-cholesterol diet will drop blood cholesterol levels into the healthy range. In children with hereditary problems, however, drug therapy may be necessary in addition to the dietary changes. Typically, drugs are not used in children before age 10 and are only prescribed after six to 12 months of dietary therapy have failed to sufficiently lower the cholesterol level.

Even if a child’s cholesterol level is normal, it is a good idea to limit fat and cholesterol in the diet. The American Academy of Pediatrics recommends the following for all healthy children 2 years and older: Total fat intake should not exceed 30% of total calories, saturated fat intake should be less than 10% of total calories and dietary cholesterol consumption should be less than 300 milligrams a day.

Children younger than 2 should not have any restrictions on fat and cholesterol intake, as these substances are needed early in life for normal growth and development.

Lean Toward the Low-Fat Snacks

Limiting fat and cholesterol in a child’s diet can be difficult, particularly at snack time. Many traditional snack foods, like potato chips, cookies and ice cream, are extremely high in fat. Here are some healthy low-fat alternatives: fresh fruits and vegetables, low-fat or nonfat yogurt, dried fruits, pretzels, baked potato chips or tortilla chips, low-fat cheese, popcorn popped in unsaturated oil or air-popped, sandwiches made with low-fat meats, frozen yogurt, sorbet and sherbet, low-fat crackers and cookies, bagels.

*

Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at ourhealth@dhs.co.la.ca.us.